Provider Demographics
NPI:1609632181
Name:WHEATLEY-HODGE, DAWN RENEE (MFT ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:RENEE
Last Name:WHEATLEY-HODGE
Suffix:
Gender:F
Credentials:MFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10307 BEAU BRUMMELL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRDALE
Mailing Address - State:KY
Mailing Address - Zip Code:40118-9417
Mailing Address - Country:US
Mailing Address - Phone:502-432-2234
Mailing Address - Fax:
Practice Address - Street 1:4420 DIXIE HWY STE 230
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2986
Practice Address - Country:US
Practice Address - Phone:502-432-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY289767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist